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SIGNED, SEALED AND DATED this day of 14e wt h e r Zo <br /> i <br /> Operator ' (SEAL) <br /> By: <br /> Title: j�� Ow✓I QJ' <br /> NOT IARIZATION OF OPERATOR'S ACKNOWLEDGEMENT <br /> STATE OF 0,9 coo ) <br /> ss.: <br /> COUNTY OF e //-0►— ) <br /> " zo I �l <br /> The foregoing instrument was acknowledged before me this c�5-4 day of Qi QA r , , <br /> by w, as ()uw re r of TigQc—T,rA LerA- c u.P.1 . <br /> SUSAN A GREENE Notary Public Dl <br /> NOTARY PUBLIC My Commission Expires <br /> STATE OF COLORADO <br /> NOTARY ID 20054045242 <br /> MY COMMISSION EXPIRES DECEMBER 4,2017 <br /> DEPARTMENT OF NATURAL RESOURCES <br /> MINED LAND RECLAMATION BOARD <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> By: Date Executed: <br /> Division Director <br /> Rev. 05/12 <br /> - 13 - <br />